Letter from the President

I am honored, humbled, and grateful to have the unique opportunity to serve as the California Academy of Child and Adolescent Psychiatry (CALACAP) President for 2019 and 2020. The next two years likely will present multiple challenges for our organization and its members, emanating both from Washington, D.C. and Sacramento, but also perhaps unparalleled opportunities to advocate for improving mental health care and conditions for children and adolescents across the state.

Over the past two years, we (as physicians and child & adolescent psychiatrists) have weathered a storm from Washington, D.C., which has included an attempted repeal of the Affordable Care Act (and potential attendant issues related to access), patients’ potential mental health issues related to separation of migrant children from their parents, and numerous other challenges. However, with the 2018 election results changing the composition of the U.S. House of Representatives, fresh national perspectives on access to health care, addressing mental health/healthcare workforce shortages, and improving children’s mental health may emerge. And with the enactment of the “First Step Act” (related to criminal justice reform), some embers of bipartisanship appear to be reigniting in the Capitol.

During this same time period (i.e., 2017-2019), California has continued to serve as a beacon of progressiveness, resilience, and compassion for those at the margins of society. For example, multiple pieces of legislation have been passed to address juvenile justice and adult criminal justice reform, and prevention and diversion of individuals from the juvenile justice and adult correctional systems have been prioritized. Addressing mental health concerns is a crucial component to the ultimate success of these initiatives and reforms. CALACAP has been at the forefront of advocating for measures that would improve the mental health treatment of the disadvantaged. Additionally, our organization has been integral in helping the legislature, governor, and various state departments/agencies address workforce shortage problems, “access to care” issues, and other “bread and butter” topics related to child & adolescent psychiatry.

However, we have faced some challenges, too, on the state level. Multiple pieces of legislation seem essentially to have put blame on psychiatrists for systems’ problems and failures. Therefore, the legislative “fixes,” and subsequent increased regulations and burdens on psychiatrists, likely will not remedy the underlying problems. Despite these setbacks, CALACAP has, through our presence in Sacramento, managed to advocate for both child & adolescent psychiatrists and our patients. We have helped modify well-intentioned, though ill-advised legislation and tempered the potential negative effects of such legislation through our work with our legislative advocate (Melissa Immel of Shaw Yoder Antwih), legislators, and their staffs. This year, we may take the next step of co-sponsoring our own piece of legislation.

From an “executive branch”-perspective, with the start of Governor Newsom’s administration, CALACAP has perhaps an unprecedented opportunity to work with a chief executive who appreciates fully the individual and societal importance of early childhood education and making a positive impact on the “developing brain.” He has proposed dedicating $1.8B to an array of programs that are designed to improve access to early education and child-care. I am eager to have CALACAP partner with Governor Newsom and his administration, as well as with other organizations (both public and private), in this visionary and bold venture.

Somewhat similarly, CALACAP has an extraordinary opportunity (and duty) to help shape both policymakers’ and the public’s approach to the implementation and promulgation of new technologies that may have significant impact on issues related to child & adolescent psychiatry. Multiple topic areas would benefit from CALACAP’s individual members’ and collective organizational input. These include:

effective strategies for delinquency prevention, early intervention, and diversion;

responsible use of data and algorithms for risk assessment in a variety of contexts (e.g., examining social media postings to determine suicide risk, using various databases to assess risk to youth in child welfare settings).

Fortunately, CALACAP will not go this admittedly difficult road alone. In order to increase our numbers and amplify our effectiveness during legislative advocacy days (and throughout the year), we will continue to nurture partnerships with the National Alliance on Mental Illness (NAMI) California (https://namica.org) and the California Psychiatric Association (http://www.calpsych.org). We also are in the process of developing a working relationship with Children Now (https://www.childrennow.org), in order to add to the strength of our coalition. These actions will increase our voice in Sacramento and, to the extent that California is a national policy trailblazer, Washington, D.C.

The next few years will be crucial in the development and implementation of child mental health law and policy. As an organization, we have a unique opportunity to impact these domains. We will remain vocal advocates for our patients, members, and by extension, society at large. Additionally, we will continue to be educators of and collaborators with our own members, physicians from different disciplines, legislators, other policymakers, and the general public. By utilizing the individual and collective expertise of our membership, and by leveraging the power of our partnerships and coalitions, we can both effectively address the inevitable challenges we will face and take advantage of the unique opportunities with which we are presented. Many thanks for joining me on this mission!